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- Susan F. Townsend, MD, FAAP*
- *Associate Clinical Professor, Department of Pediatrics, UC Denver School of Medicine; Affiliate Faculty, Program in Bioethics, UC Denver, Denver, CO
Author Disclosure
Dr Townsend has disclosed no financial relationships relevant to this article. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.
Introduction
Emerging therapies today offer the promise of treatment for “fetal patients.” Because of this focus, fetal interests have increasingly been considered separately from maternal interests by clinicians, policy makers, and the bioethics community. Nonetheless, pregnancy creates a unique circumstance in medical ethics because the fetus can be accessed only through intervention on the pregnant woman. Although maternal and fetal interests usually are aligned, care of the fetus is intertwined with and dependent on care of the pregnant woman, and at times conflict can arise between fetal and maternal interests. This circumstance is termed “obstetric” or “maternal-fetal” conflict. These are emotionally laden issues that involve protecting the rights of women and the best interests of the fetus. This review will outline some ethical constructs that may be used to help resolve such conflicts.
Ethical Frameworks Used to Resolve Obstetric Conflicts
When conflict arises between maternal and fetal interests (eg, refusing a cesarean delivery for fetal distress, or treatment of cancer during pregnancy that could result in fetal death), more than one ethical theory may be useful to aid decision-making. (1) Principle-based theories use the principles of respect for patient autonomy, beneficence/nonmaleficence, and justice to guide conflict resolution. (2) Other helpful approaches to obstetric conflict, in particular, include feminist theory and the ethics of care. (1)(3) Because of the emotionally laden issues involved in protecting both the rights of women and the best interests of the fetus, conflicts often are approached best by using a comprehensive analysis that incorporates a variety of perspectives. Pediatricians and pediatric subspecialists who care for the child after delivery can play an important role in helping provide perspective about potential fetal outcomes.
Feminist theory …
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